Provider Demographics
NPI:1851675664
Name:BUSENBARK, CHRISTI L (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:L
Last Name:BUSENBARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:L
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0344
Mailing Address - Country:US
Mailing Address - Phone:765-828-1003
Mailing Address - Fax:765-828-1030
Practice Address - Street 1:777 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2493
Practice Address - Country:US
Practice Address - Phone:765-828-1003
Practice Address - Fax:765-828-1030
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003729A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201039780Medicaid
INM400058964Medicare PIN
INM400058966Medicare PIN